FSI Inspection Form
FSI Inspection Form
FSI Inspection Form
Name of Vessel:
Date of Inspection
(dd/mm/yy)
Start:
Type of Inspection:
NAME OF INSPECTOR:
Finish:
First
Annual
Occasional
ID NUMBER:
INSPECTION REPORTS: This inspection form is to be signed by the Inspector and the Master of the vessel. The original shall remain onboard kept by the Master as one of the vessels official documents.
PART A: - GENERAL
1.Official No.
2. IMO No
3. Call Sign
8. Recognised
Organisation:
9. Recognised Security
Organisation:
10. Classification Society
(+class notation):
11. ETA/Next Port:
6. Length
8. Vessel Type
4. Caribship No.
Unrestricted
Restricted
Tel
Fax
Email
Mobile
Mobile
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
14. Name of Maritime
Resident Agent
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Issued
dd/mm/yyyy
Expiration
dd/mm/yyyy
Last
Endorsement
dd/mm/yyyy
IOPP Supplement
IAPP Supplement
Exemptions
Certificate of Class
MLC
Other Certificates
Issued By
Issued
dd/mm/yyyy
Expiration
dd/mm/yyyy
Last
Endorsement
dd/mm/yyyy
Certificate of Registry
CLC Bunkers
Port
Date
dd/mm/yyyy
Detained?
No. of detainable
deficiencies
Yes
No
Remarks:
Yes
No
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Remarks:
Yes
No
Remarks:
Yes
No
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Remarks
1.
2.
3.
4.
8.
9.
5.
6.
7.
10.
11.
12.
13.
14.
PART D: - Records
Records
Y/N
Last
Entry
Records
Y/N
Last Entry
12
13
14
15
16
17
18
19
20
10
21
11
PART E:
Publications and Charts
Y/N/
NA
Last
Pub.
Y/N/
NA
Last Entry
Navigational Charts
13
ISGOTT (tankers)
Pilot Charts
14
IGC Code
15
Notices to Mariners
16
Nautical Almanac
17
Tide Tables
18
Navigation Tables
19
MARPOL
20
COLREGS
21
ISM Code
22
10
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
11
ISPS Code
23
12
IMDG Code
24
27
28
29
International Medical Guide for Ships (World Health Organization) latest edition
25
26
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
PART F:
Bridge Logbooks
Y/N
Last Entry
Bridge Logbooks
Last Entry
Y/N
Fire Drills
Lookout on Duty
10
Accidents
11
12
Inspection of LSA
13
Helmsman on Duty
14
Security exercises
Remarks:
Y/N
SHORE BASED
MAINTENANCE
CONTRACT
Type of Maintenance
Duplicated System
VHF
MF/HF
MMSI Number
INMARSAT SES
Y/N
Y/N
Equipment
19
Magnetic Compass
Date Last Adjusted
Y/N
Y/N
Y/N
a. LSD/DCS
Radar (9 GHz)
b. Radiotelephony
c. Direct-printing telegraphy
c. Radiotelephony
21
22
23
NAVTEX Receiver
24
25
Radar Transponder
26
15
27
16
28
SART
29
LRIT System
GPS
30
AIS
31
BNTERRWAS
17
.
18
.
10
.
11
.
12
.
13
.
14
.
Remarks:
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Certificate of Endorsement
Position
Master
Expiration
Date
Expiration
Date
Chief Mate
Deck Officer
Deck Officer
Deck Officer
Radio Officer
Chief Engineer
2nd Engineer
Engineer Officer
10
Engineer Officer
11
Engineer Officer
12
RATINGS
Deck
Name
Engine
Grade
Number
Nationality
Grade
Electro Technical
Other
STCW Grade
II/4
II/5
III/4
III/5
III/6
III/7
N/A
N/A
13
Number
14
15
Total
Remarks:
Indicate if current officers and ratings conform to the vessels Minimum Safe Manning Certif. Y/N
17
Safety Training
18 Is there any type of documentation of the crews familiarization with the vessels emergency procedures and operation? Y/N
Remarks:
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GMDSS
certification
Endorsements
Y/N
Y/N
St Kitts & Nevis International Ship Registry Flag State Inspection Report
Lifeboats
Number
Total
Capacity
Port
Starboard
Free Fall
Annual maintenance of
lifeboat davits and
WINCHES by a
recognised company
Date
Name of
company
Rescue boat
Liferafts
[a) Port
[b) Starboard
[c] Other
With motor
Y/N
Lifebuoys
8
9
10
11
12
13
1
2
Initial
deployment
Y/N
With
lifelines
Y/N
StandardLifejackets
Childrens
lifejackets
Extra large (140kg)
Immersion suits
Thermal protective
aids
Signals
Number
Expiration date
Rocket parachute flares
Line-throwing appliance
Number of rockets
Fire & Abandon Ship Drills observed by inspector Y/N
NOTE TO INSPECTOR:
At least partial drills may be asked for.
Exercise descriptions
Number
Part J: Fire Fighting Equipment
Main Fire pumps
Emergency fire pump (Fore) Must Be Tested
(Aft) - Must Be Tested
3
4
5
6
7
Fire main
Fire hoses
Dual Fire nozzles with shutoff (spray/jet type)
Portable Fire extinguishers
Fixed fire-extinguishing systems in machinery
spaces
Visible conditions
Fire-extinguishing arrangements in cargo spaces
9
10
11
Visible conditions
Fixed fire detection and fire alarm systems
Watertight doors
Escape openings (hatches) unobstructed?
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Visible condition
of boat and
launching
appliances
Appropriate
stowage
Y
N
With
whistle
Y/N
7
Last date
lowered
to the
water
Name of
company
Date
5 yearly
load test of
lifeboat
davits and
winches
by
recognised
company
Engine
Tested
Y
N
5
Operating instructions for survival craft visible Y/N
Personal LSA
Number
With
With
reflective lights Y/N
tape Y/N
6
Type
With
smoke
signals
Y/N
Last date
Visible
of service conditions
Visible conditions
Visible conditions
Expiration date
Visible conditions
Type
Type
Last date of
inspection
Last date of
inspection
Operation Y/N
Satisfactory condition Y/N
Y/N
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Emergency source of
electrical power
Type
[a] Generator
[b] Accumulator battery
Emergency equipment
Number
10 Firemans outfit
Breathing apparatus
Complete set
Visible conditions
Spare charges
6
7
Y/N
Y/N
9
10
11
12
13
14
15
16
17
18
19
Mooring lines
Cargo handling equipment
Accommodation ladder
Pilot ladder
Crew Accommodation and recreational facilities
Hospital Medical facilities
Y/N
Internal spaces
Galleys Y/N
Pantri
Y/N
Handling
Y/N
es
spaces
Y/N
Refrigerator spaces
Y/N
20
21
Restricted areas
22
External
Y/N
Weather Decks
Y/N
Super structures ect
Hull
Gangways (including safety nets)
Accommodation Ladders Y/N
Step
23
Y/N
24
25
26
28
Y/N
Y/N
Guard Rails
27
Clean and
Free of
Vermin
Y/N
Y/N
Y/N
Stairways
Fittings
Y/N
Y/N
LAST TEST DATE:
Portholes
Y/N
Other
closing
devices
Y/N
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
29
If MODU or FPSO,
ANNEX PART C.
IMPORTANT NOTICE
NEITHER THE INSPECTION NOR THE REPORT CONSTITUTES A CERTIFICATION, WARRANTY OR OTHER REPRESENTATION AS TO THE
SEAWORTHINESS OF THE VESSEL DESCRIBED HEREIN NOR DO THEY RELIEVE ANY PERSON OR ORGANIZATION FROM THEIR
RESPONSIBILITIES AND OBLIGATIONS TO ENSURE THAT THE VESSEL IS MAINTAINED IN A SEAWORTHY CONDITION.
INSPECTOR
PRINT NAME :
Sign:
ID #
NOTICE TO MASTERS:
Masters are required to review all entries in this report before signing it. It is recommended that they discuss with inspector any findings which may not
agree with actual condition prevailing on board at the time of inspection.
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Signature of inspector
Name (print)
Signature of master
Name (print)
Date
Date
INSPECTOR NO.
Vessels stamp
REV. 28/03/2014
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
Name of vessel:
Official number
Deficiencies List:
REV. 28/03/2014
Port of inspection:
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
14
15
16
10
11
12
13
17
18
19
20
21
22
23
24
25
26
27
NOTES
REMARKS:
SIGNATURE OF INSPECTOR
NAME (PRINT)
DATE
INSPECTOR NO.
REV. 28/03/2014
SIGNATURE OF MASTER
NAME (PRINT)
DATE
VESSELS STAMP
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
NOTES
5
6
7
8
9
10
11
12
13
14
15
16
17
18
REMARKS:
SIGNATURE OF INSPECTOR:
NAME (PRINT)
DATE
INSPECTOR NO.
REV. 28/03/2014
SIGNATURE OF MASTER
NAME (PRINT)
DATE
VESSELS STAMP
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St Kitts & Nevis International Ship Registry Flag State Inspection Report
ANNEX PART C: MOBILE OFFSHORE DRILLING UNITS
AND FLOATING PRODUCTION STORAGE OFFLOADING
FACILITY (APPLICABLE 1989 MODU CODE AS AMENDED
IN 1991)
NOTES
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
REMARKS:
SIGNATURE OF INSPECTOR
NAME (PRINT)
DATE
INSPECTOR NO.
REV. 28/03/2014
SIGNATURE OF MASTER
NAME (PRINT)
DATE
VESSELS STAMP
Page 16 of 16